ORIGINAL
    REC~VED
    CLERK’S OFACE
    JAN
    2
    4
    2005
    STATE OF ILLJNOIS
    Pollution Control Board
    SENDER
    COMPLETE THIS SECTION
    Complete items
    1, 2,
    and 3. Also complete
    item
    4
    if Restricted
    Delivery is desired.
    •
    Print your name and address on the reverse
    so that we can
    return the card to you.
    •
    Attach
    this card to the
    back of the mailpiece,
    or on the front if space permits.
    1.
    Article Addressed to:
    1/6/05
    B.M.
    AC 2004—084
    John Pruden
    City of Salem
    101 South Broadway
    Salem,
    IL 62881—1699
    4.
    Restricted
    Delivery?
    (Extra Fee)
    0
    Yes
    2.
    Article
    Number
    (Transfer from service labeg9
    7004
    0750
    0004
    3960
    2250
    PS Form
    3811,
    February 2004
    Domestic Return
    Receipt
    1o2595-os-M-154o
    A.
    r’~nature
    o
    Agent
    o
    Addressee
    sry address different from
    item
    1?
    0
    Yes
    If YES,
    enter delivery address below:
    0
    No
    3.
    Spvice
    Type
    ~..Certified Mail
    1J
    Registered
    0
    Insured
    Mail
    o
    Express
    Mail
    o
    Return
    Receipt for Merchandise
    Dc.o.D.

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